Breastfeeding and Nipple Confusion

Caucasian mother breastfeeding baby son on sofa
JGI/Jamie Grill / Getty Images

Nipple confusion, also called nipple preference, sometimes occurs when breastfed babies are given artificial nipples (such as bottle nipples and pacifiers) soon after birth. Infants learn to suck differently on different types of nipples. The shape of a pacifier or bottle nipple is not the same as the shape of the nipple on a breast. The flow of milk from a bottle nipple is also different.

Overview

When a baby gets used to the difference in sucking pattern and flow, they might get confused and start having difficulty sucking at the breast. They might even refuse the breast altogether.

Nipple confusion does not happen with all babies. Some infants can use a pacifier and go back and forth from breast to bottle without issue while others find these transitions difficult. If possible, many lactation experts advise waiting to introduce an artificial nipple until your baby is about 4 weeks old and breastfeeding well.

A baby is more likely to experience nipple confusion when a pacifier or bottle is introduced before breastfeeding has become well established.

Latch-On Problems

Babies with nipple confusion will often have latch-on difficulties. When they are breastfeeding, babies become accustomed to the anatomy of the breast. For example, if the person breastfeeding them has flat or inverted nipples and they give their baby a bottle too early, the baby will find that latching on to a bottle with a protruding nipple is easier than latching on to the breast.

The flow of the bottle nipple is also faster, and the feeling is much ​more firm. So, going back to the breast once the baby has become accustomed to easier bottle feedings might prove frustrating.

Sucking Problems

Babies who are nipple confused might also learn incorrect sucking patterns, which can cause problems for the person breastfeeding (like sore nipples and a low breast milk supply). When babies take bottles, their mouths do not have to latch on to the artificial nipple the same way they latch onto the breast.

A baby's mouth can gently glide onto the bottle whereas they must open their mouth wide to latch on to the breast.

The person who is breastfeeding can end up with sore nipples if the baby's mouth is not latched onto their breast deeply enough. Their supply of breast milk will also suffer because the milk ducts are not getting properly compressed.

Breast Refusal

People who are breastfeeding sometimes worry that their baby isn't getting enough breast milk in the first few days after birth. They might offer bottles to satisfy their newborns. While the baby might content, they likely have been given more than they need.

A baby's stomach is the size of a marble on Day 1. Giving them a 2-ounce bottle will stretch the stomach abnormally.

After being given a bottle, if a baby goes back to the breast for the next feeding, the caregivers might become frustrated to realize the baby is not getting as much as they did with the bottle. Often, this is when the baby will start to refuse the breast.

Possible Benefits of Bottles

Generally speaking, if a baby has been given a bottle or pacifier too early, they might end up with incorrect sucking patterns at the breast. At the same time, there are situations where special bottles may help babies who have sucking issues to learn to breastfeed correctly. 

Special feeding bottles with long nipples reach the area where the hard and soft palates meet. These have been known to help babies with severe sucking problems to transition to breastfeeding because they mimic the process.

How to Avoid Nipple Confusion

The easiest way to avoid nipple confusion is to wait to introduce a bottle or pacifier to your baby. You can also try paced bottle feeding, which is a method of bottle feeding that helps prevent a flow preference. Whenever a bottle is offered, paced bottle feeding should be used to slow the flow of milk.

Paced bottle feeds allow the baby to alternate between breast and bottle more easily than babies who are not fed with this technique. Exclusively breastfeeding is recommended for the first two to three weeks. It is important that your baby is latching on well and that your milk supply is well-established. At that point, you can introduce a bottle—perhaps starting with once a day, using expressed breast milk.

A Word From Verywell

If you have to return to work and need the baby to take a bottle, around three weeks is the ideal time to get started because most babies can go back and forth from the breast to a bottle easily at this stage.

Was this page helpful?
Article Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zimmerman E, Thompson K. Clarifying nipple confusion. J Perinatol. 2015;35(11):895-9. doi:10.1038/jp.2015.83

Additional Reading
  • American Academy of Pediatrics. New Mother’s Guide To Breastfeeding. Bantam Books. New York. 2011.
  • Lawrence, Ruth A., MD, Lawrence, Robert M., MD. Breastfeeding A Guide For The Medical Profession Seventh Edition.  Mosby. 2011.